An inquiry into the mechanism of hypertriglyceridemia in patients with chronic renal failure

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Abstract
The current study was undertaken to investigate the relationship between plasma triglyceride concentration and both very low density lipoprotein secretion rate and postprandial insulin response in patients with chronic renal failure. The results documented a statistically significant (P < 0.01) direct relationship between plasma triglyceride concentration and very low density lipoprotein secretion rate, as well as between plasma triglyceride concentration and postprandial insulin response. Although similar correlations have been described in subjects with normal renal function, the quantitative nature of these relationships was different in patients with chronic renal failure. Plasma triglyceride concentration in these patients was higher at any given very low density lipoprotein secretion rate, indicating that uremia leads to a defect in removal of very low density lipoproteins from plasma. On the other hand, plasma triglyceride concentrations were lower at any given postprandial insulin response in uremic patients. Although plasma triglyceride concentration in patients with chronic renal failure will depend to a large extent upon the nature of the relationships that exist between these variables in the specific patient at any given time, these relationships can be acutely modulated. Thus, decreasing dietary carbohydrate intake by 15% led to a significant fall in postprandial insulin response, very low-density lipoprotein secretion, and plasma triglyceride concentration. These latter results emphasize the importance of environmental influences on plasma triglyceride concentration, and suggest that lowering postprandial insulin response by other means should also ameliorate hypertriglyceridemia in patients with chronic renal failure.